NCC222478_Contact Update Record (Leg Resp Change)_20220812

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 8/12/2022 12:17:54 PM (Contact Changes Submitted)

Certificate of NCC222478
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2022-2478
Original NOI No.* 96726
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Appleton South, LLC
Project Name Appleton South
Address Hampton Ridge Road, Fayetteville, NC
County Cumberland
Latitude 35.1435
Longitude-78.8955
Date COC Issued* 07/11/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?*
Legally Responsible Individual Only
Site Contact Only
• BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'to revise Billing Contact details.
Changed?
U No
Yes
Billing Email
[e-mail]
NEW Billing Email
[e-mail]
Billing Telephone No.
910-302-3608
NEW Billing
[phone]
Telephone No.
(Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible D. Ralph Huff III
Individual (Previous)
First Name (New)* David
Last Name (New)* Vannoy

NEW Legally Reflects any revisions above
Responsible David Vannoy
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 2919 Breezewood Avenue, Suite 100,
Address (Previous) Fayetteville, NC 28303-5283
NEW Permittee Street Address
Mailing Address* 2919 Breezewood Avenue
Address Line 2
Suite 100
City
State / Province / Region
Fayetteville
NC
Postal / Zip Code
Country
28303-5283
us
Permittee Street 2919 Breezewood Avenue, Suite 100,
Address (Previous) Fayetteville, NC 28303-5283
NEW Permittee Street Street Address
Address* 2919 Breezewood Avenue
Address Line 2
Suite 100
City
State / Province / Region
Fayetteville
NC
Postal / Zip Code
Country
28303-5283
us
Site Contact
(Previous)
Site Contact Title
(Previous)
Organization
(Previous)
First Name (New)*
Last Name (New) *
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
D. Ralph Huff III
Manager
Appleton South, LLC
David
Vannoy

NEW Site Contact* Reflects any revisions above
David Vannoy
NEW Site Contact Manager
Title
NEW Organization Appleton South, LLC
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 910-302-3608
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 2919 Breezewood Avenue, Suite 100,
Address (Previous) Fayetteville, NC 28303-5283
NEW Site Contact Street Address
Mailing Address* 2919 Breezewood Avenue
Address Line 2
Suite 100
City
State / Province / Region
Fayetteville
NC
Postal / Zip Code
Country
28303-5283
us
Change Requested David Vannoy via Modification request submitted 7/14/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 08/12/2022